Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar;53(3):143-150.
doi: 10.2519/jospt.2022.11369. Epub 2022 Dec 12.

Improved Outcomes Following a Care Guideline Implementation: Part 1 of an Analysis of 12 355 Patients After Total Knee Arthroplasty

Kate I Minick, Stephen J Hunter, Jacob J Capin, Jennifer E Stevens-Lapsley, Gregory L Snow, Devyn Woodfield, Pam Dibblee, Gerard P Brennan

Improved Outcomes Following a Care Guideline Implementation: Part 1 of an Analysis of 12 355 Patients After Total Knee Arthroplasty

Kate I Minick et al. J Orthop Sports Phys Ther. 2023 Mar.

Abstract

OBJECTIVE: To describe the application and examine the influence of a continuous quality improvement intervention, which had a goal of standardizing care to reduce the proportion of patients who do not have a meaningful improvement in patient-reported outcomes following total knee arthroplasty (TKA). DESIGN: Continuous quality improvement. METHODS: A physical therapy (PT) care guideline was initiated in 2013 for patients following TKA. The Knee Outcome Survey - Activities of Daily Living (KOS-ADL) was measured at every visit, and scores were extracted from a clinical outcomes database to calculate the proportion of patients who did not achieve a minimal clinically important difference. Based on logistic regression analysis, we compared the proportion of patients who did not progress on the KOS-ADL in a non-care guideline group (2008-2012) to a care guideline (CG) group (2014-2019). RESULTS: This study included 12 355 patients (aged 18-92 years) following TKA incurring at least 3 PT visits from 2008 to 2019. The percentage of patients who did not progress in the non-care guideline group was 25.8% and in the care guideline group 14.3% (P<0.001). The relationship between care guideline adherence and lack of progression on the KOS-ADL was statistically significant, X2 (df = 1) = 148.7, P<.001. CONCLUSION: The percentage of patients who did not achieve meaningful progress on the KOS-ADL declined significantly in the 6 years after implementing a TKA care guideline without an increase in the number of clinical visits. The standardized care guideline was associated with meaningful improvements for patients following TKA when applied in conjunction with PT access to outcome data, feedback through audits, performance goals, and financial incentives. J Orthop Sports Phys Ther 2023;53(3):143-150. Epub: 12 December 2022. doi:10.2519/jospt.2022.11369.

Keywords: care guidelines; implementation; patient-reported outcomes; quality improvement; rehabilitation; total knee arthroplasty.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure and Conflict of Interest: The authors have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript, except as disclosed in an attachment and cited in the manuscript. Any other conflict of interest (i.e., personal associations or involvement as a director, officer, or expert witness) is also disclosed in an attachment.

Figures

FIGURE 1.
FIGURE 1.
A condensed dashboard image demonstrating the on-demand access to patient outcomes. The two lines represent average PT visits when a minimum of 3 visits were completed (top line) and the average Failure to Progress (FTP) percentage each year (bottom line).
FIGURE 2.
FIGURE 2.
Line graph showing failure to progress (FTP) over time adjusting for covariates. The dotted line indicates 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Avramidis K, Karachalios T, Popotonasios K, Sacorafas D, Papathanasiades AA, Malizos KN. Does Electric Stimulation of the Vastus Medialis Muscle Influence Rehabilitation After Total Knee Replacement? Orthopedics. 2011;34(3):175–175. doi:10.3928/01477447-20110124-06 - DOI - PubMed
    1. Avramidis K, Strike PW, Taylor PN, Swain ID. Effectiveness of electric stimulation of the vastus medialis muscle in the rehabilitation of patients after total knee arthroplasty11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated. Arch Phys Med Rehabil. 2003;84(12):1850–1853. doi:10.1016/S0003-9993(03)00429-5 - DOI - PubMed
    1. Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3(1):32. doi:10.1186/s40359-015-0089-9 - DOI - PMC - PubMed
    1. Beckwée D, Bautmans I, Lefeber N, Lievens P, Scheerlinck T, Vaes P. Effect of Transcutaneous Electric Nerve Stimulation on Pain after Total Knee Arthroplasty: A Blind Randomized Controlled Trial. J Knee Surg. 2018;31(02):189–196. doi:10.1055/s-0037-1602134 - DOI - PubMed
    1. Bekkering GE, Hendriks HJM, van Tulder MW, et al. Effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain: a cluster randomised controlled trial. Qual Saf Health Care. 2005;14(2):107–112. doi:10.1136/qshc.2003.009357 - DOI - PMC - PubMed

Publication types

LinkOut - more resources